I Russian Congress with foreign participants “Emergency endoscopy”. Materials of conference. Part 2.

Information from the ARCMA “Zashchita”.

Nutritional support in emergency medicine.

Abstract. Examined and treated 114 patients with isolated severe head injury at the age of 18 to 55 years. Group I included 61 patients who survived, in group II — 53 patients who died on the 3–15th day post-traumatic period. Patients I and II groups had complex intensive therapy according to existing protocols. 15 patients (subgroup I1 ) was prepared in the complex therapy mexidol 1200 mg per day for 7–10 days. Against the background of mexidol decreased intensity of lipid peroxidation, maintained at a sufficient level power antioxidant defense system cells, there was an earlier resolution of post-traumatic encephalopathy and recovery of consciousness. The treatment mexidol noted more favorable during the early post-traumatic period, a reduction of complications (χ2 =55,4; p<0,0001) — syndrome of acute lung injury, disseminated intravascular coagulation, acute cardiovascular failure, and pneumonia.

Purpose. The identifying of the nature of growth of myoma nodes during the pregnancy, of the cause of the uterine fibroids relapse after conservative myomectomy during the pregnancy.

Material and methods. Тhе сlinical, histologic and morphometric studies of remote myoma nodes during pregnancy were conducted in 41 women and among of 9 patients in this group with recurrent uterine fibroids after conservative myomectomy.

Results. The paper presents the results of morphological and morphometric studies on remote for emergency indications myoma nodes during the pregnancy and the clinical results of the operations. There were found that 78% of women with the growing myoma nodes during pregnancy due to myocyte hypertrophy and secondary changes, and in 22% of patients diagnosed true growth of proliferating fibroids. The both variants of growth nodes were accompanied by clinically and morphological features of the malnutrition of the tumor. The recurrence of the proliferating uterine fibroids was detected in all the cases in the late periods.

Conclusion. More than one fifth of pregnant women with uterine tumor growth is due to a true increase in the proliferating. It is in this cohort in the late periods (2–4 years) relapse of uterine fibroids. The urgency of the problem early relapse prevention of the proliferating uterine fibroids after conservative myomectomy during the pregnancy resulting from the lactation. 

Purpose. In the last 10 years in the treatment of acute jaundice, developed on a background of malignant tumors of the pancreatobiliary zone (PBZ), more preferred method is endoscopic retrograde biliary drainage.

Material and methods. From January 2007 to July 2012 in the clinic of hospital surgery N. 2 PRNMU endoscopic biliary stenting was performed in 441 patients. Of these, 324 (73.5%) stenting fell to 234 patients with a tumor of the extrahepatic bile ducts. The diagnostic program included ultrasonography, computed tomography, endoscopic ultrasonography and endoscopic retrograde cholangiopancreaticography.

Results. Installing of bilioduodenal stent in 223 patients (95.3%) was generated after the pre-endoscopic papillosphincterotomy (EPST). The adequacy of the biliary drainage after produced in the required amount of biliary stent placement was achieved in all patients. In 46 cases, execute the biliary tract prosthesis failed. Complications of endoscopic interventions presented with acute pancreatitis, cholangitis, bleeding from the area of EPST, perforated duodenal wall and migration of the stent were in 19 cases (5?9%). Postoperative mortality was 3?8%. 7 patients (3%) died after the endoscopic decompression of the biliary tract. After stenting in all patients with jaundice it was resolved or significantly reduced. In 185 of them (79%) was the definitive guide endoscopic treatment because of severity of tumor process. In cases of jaundice reccurence endoscopic stent recanalizing or replacement were performed. In the remaining cases (21%) patients after the resolution of jaundice decompressive surgical intervention were done.

Conclusion. The method of endoscopic retrograde biliary drainage allows you to prepare patients with obstructive jaundice for surgical intervention, including the radical. The frequency of complications after endoscopic retrograde operations on the major duodenal papilla for acute jaundice blastomatous origin did not differ from that after the standard retrograde interventions and was 6%. 

ABSTRACT. The authors present two clinical cases of foreign bodies of the larynx in young children. Peculiarity of the first case is rare finding of the foreign body in the larynx at the 7-month-old baby with quite large in the form as the plastic fragments of the pen cap. Peculiarity of the represented second case is rare finding of the foreign body in the larynx at the one-year-old child with enough big sizes as the fragment of an egg shell. Despite the large sizes of the aspirated objects and their localization at the level of the glottis of the larynx children breathed through the natural airway. The foreign bodies were removed through the natural way with the aid of direct laryngoscopy, avoiding complications. 

ABSTRACT. The author presents the clinic case: an unusual foreign body (a teaspoon) in the esophagus. Despite the large sizes and unusual shape of the foreign body, it was removed through natural way with rigid esophagoscopy while avoiding complications. 

Parenteral nutrition in patients in critical conditions: the history of formation and development problem.

Leonid M. Roshal. To the 80-th anniversary of the birth.

Aleksandr F. Chernousov. To the 75-th anniversary of the birth.

Russian Scientific Center of Surgery named after academician B.V. Petrovskiy. To the 50-th anniversary of the foundation.

Источник: Aliti GB, Rabelo ER, Clausell N, et al. Aggressive Fluidand Sodium Restrictionin Acute Decompensated Heart Failure: A Randomized Clinical Trial // JAMA Intern Med. – 2013. – Vol. 173, N. 12. – P. 1058–1064.

Источник: Deftereos S., Giannopoulos G., Raisakis K., et al. Colchicine Treatment for the Prevention of Bare-Metal Stent Restenosisin Diabetic Patients. // J. Am. Coll. Cardiol. – 2013. – Vol. 61. – P. 1679–1685.

Источник: Shlamovitz G.Z., Mower W.R., Bergman J., et al. How (Un)Useful is the Pelvic Ring Stability Examination in Diagnosing Mechanically Unstable Pelvic Fractures in Blunt Trauma Patients? // J. Trauma. – 2009.– Vol. 66, N. 3. – P. 815.

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Alexander Aleksandrovich Vishnevsky (25.12.1939 — 30.05.2013).